Compliance With Vaccination Recommendations in the IBD Population: The Effect of a Formal Health Maintenance Program

Abstract

Introduction: Influenza and pneumococcal infections are prevalent diseases in the general population, and patients with inflammatory bowel disease (IBD) are more susceptible to these infections, particularly those on immunosuppressive medications. Preventive measures include annual influenza vaccination and a one-time pneumococcal vaccination followed by re-vaccination 5 years later. Our goal was to evaluate the effectiveness of a health maintenance program (HMP) started in December 2011 aimed at improving compliance with these recommendations. Prior to that date, recommendations for pneumococcal and influenza vaccinations were made at the discretion of the treating gastroenterologist. The HMP included: 1) a check list of health maintenance measures reviewed with the patient at the time of the office visit, and shared with the treating primary care physician; 2) administration of the vaccines in the GI clinic at the time of the office visit; 3) reminder letters sent a few months following the office visit if the vaccinations were not done in the office. Methods: This is a retrospective study looking at IBD patients seen between January 2005 and January 2014, and comparing the compliance with influenza and pneumococcal vaccination before and after the implementation of the HMP. Out of 740 patients seen during this time, we randomly selected to review the data on 200 IBD patients on immunomodulators and/or biologics. Results: The patient’s ages ranged from 20-91 years old with a median age of 35 and a mean age of 38. Of the 200 patients, 128 were seen before and after the implementation of the HMP, and 72 were seen only after the implementation of the program. Of the 128 seen both before and after the HMP implementation, only 12 patients (10%) received the influenza vaccine before the HMP, and 63 (50%) after the HMP implementation, (p< 0.05). In this same group of patients, 40 patients (31%) had the pneumococcal vaccine before the HMP, and 62 (48%) after the HMP implementation, (p<0.05). Of the patients seen only after the implementation of the HMP, 40 patients (56%) had the influenza vaccine and 30 (42%) had the pneumococcal vaccine. Conclusion: Our data shows a significant increase in the proportion of IBD patients vaccinated against influenza and pneumococcal infections after the implementation of a HMP. We believe that explaining the importance of vaccination to patients and administering the vaccines in the GI office improves compliance with these health maintenance measures. Reasons for non-vaccinations despite these measures were not looked at, but could include patient’s refusal due to fear of side effects.